К ПРОБЛЕМЕ ДИАГНОСТИКИ В ПРЕВЕНТИВНОЙ ЭНДОДОНТИИ

Abstract

Subject. The most significant problem of modern preventive endodontics is to determine the vitality of the pulp and, accordingly, to make a decision about the choice of treatment method. The early stages of inflammation in the pulp may not be fully detected clinically and require the inclusion of additional examination methods that assess the state of microcirculation in the neurovascular bundle, as well as the severity of the immune response. These methods include: clinical and immunological examination of the gingival fluid (GF), as well as the assessment of tissue perfusion using laser Doppler flowmetry (LDF). 
 Objectives. The purpose of the study is to optimize the diagnostics of the dental pulp condition in the context of implementing the concept of preventive endodontics.
 Methodology. 37 patients aged 19–29 years with a diagnosis of K 04.00 "Pulp hyperemia" were examined. In addition to the basic methods of examination, LDF and immunological study of GF (IL-1β, TNF-α, IL-4) were used. In each patient, 1 tooth with pulp hyperemia and 1 intact (control) tooth were examined.
 Results. In the immunological analysis of DF in the area of teeth with pulp hyperemia, higher values of cytokines were obtained compared to intact teeth (p < 0.05). At the same time, in the area of 2 teeth with pulp hyperemia (5.4%), the level of cytokines was higher than their average values in the group of carious teeth. LDF of teeth with pulpal hyperemia also revealed higher values of M and σ compared with similar parameters in control teeth (p < 0.05). At the same time, in 2 cases, the highest levels of LDF were noted, which was consistent with the previously observed high values of cytokines in the gingival fluid in these loci. Moreover, after 2 weeks, a clinic of irreversible pulpitis was observed in these 2 teeth.
 Conclusion. When diagnosing reversible forms of pulpitis and deciding on the possibility of biological treatment of pulp hyperemia, it is necessary to assess the state of microcirculatory changes that have occurred in the pulp tissue, as well as the level of local immunological reactions.